WSR 19-15-142
[Filed July 24, 2019, 8:22 a.m.]
Original Notice.
Preproposal statement of inquiry was filed as WSR 19-07-054.
Title of Rule and Other Identifying Information: WAC 182-503-0050 Verification of eligibility factors, 182-503-0055 Asset verification system (new), and 182-503-0080 Washington apple healthApplication denials and withdrawals.
Hearing Location(s): On August 27, 2019, at 10:00 a.m., at the Health Care Authority (HCA), Cherry Street Plaza, Sue Crystal Conference Room 106A, 626 8th Avenue, Olympia, WA 98504. Metered public parking is available street side around building. A map is available at or directions can be obtained by calling 360-725-1000.
Date of Intended Adoption: Not sooner than August 28, 2019.
Submit Written Comments to: HCA Rules Coordinator, P.O. Box 42716, Olympia, WA 98504-2716, email, fax 360-586-9727, by August 28, 2019.
Assistance for Persons with Disabilities: Contact Amber Lougheed, phone 360-725-1349, fax 360-586-9727, telecommunication relay services 711, email, by August 23, 2019.
Purpose of the Proposal and Its Anticipated Effects, Including Any Changes in Existing Rules: As required by 42 U.S.C. Section 1396w, the agency is revising these sections and adding a new WAC section to implement an asset verification program to determine or redetermine the eligibility of an individual for Washington apple health.
Reasons Supporting Proposal: See purpose.
Statutory Authority for Adoption: RCW 41.05.021, 41.05.160; 42 U.S.C. Section 1396w.
Statute Being Implemented: RCW 41.05.021, 41.05.160.
Rule is necessary because of federal law, 42 U.S.C. Section 1396w.
Name of Proponent: HCA, governmental.
Name of Agency Personnel Responsible for Drafting: Michael Williams, P.O. Box 42716, Olympia, WA 98504-2716, 360-725-1346; Implementation and Enforcement: Mark Westenhaver, P.O. Box 45534, Olympia, WA 98504-2716 [98504-5534], 360-725-1324.
A school district fiscal impact statement is not required under RCW 28A.305.135.
A cost-benefit analysis is not required under RCW 34.05.328. RCW 34.05.328 does not apply to HCA rules unless requested by the joint administrative rules review committee or applied voluntarily.
The proposed rule does not impose more-than-minor costs on businesses. Following is a summary of the agency's analysis showing how costs were calculated. The proposed rule pertains to clients and therefore does not impose any costs on businesses.
July 24, 2019
Wendy Barcus
Rules Coordinator
AMENDATORY SECTION(Amending WSR 17-06-007, filed 2/17/17, effective 3/20/17)
WAC 182-503-0050Verification of eligibility factors.
((For the purposes of this section, "we" refers to the medicaid agency or its designee and "you" refers to the applicant for, or recipient of, health care coverage.))
(1) General rules.
(a) We may verify the information we use to determine, redetermine, or terminate your ((Washington)) apple health eligibility.
(b) We verify the eligibility factors listed in WAC 182-503-0505(3).
(c) Before we ask you to provide records to verify an eligibility factor, we use information available from state databases, including data from the department of social and health services and the department of employment security, federal databases, or commercially available databases to verify the eligibility factor.
(d) We may require information from third parties, such as employers, landlords, and insurance companies, to verify an eligibility factor if the information we received:
(i) Cannot be verified through available data sources;
(ii) Did not verify an eligibility factor; or
(iii) Is contradictory, confusing, or outdated.
(e) We do not require you to submit a record unless it is necessary to determine or redetermine your eligibility.
(f) If you can obtain verification within three business days and we determine the verification is sufficient to confirm an eligibility factor, we base our initial eligibility decision upon that record.
(g) If we are unable to verify eligibility as described in (f) of this subsection, then we may consider third-party sources.
(h) If a fee is required to obtain a necessary record, we pay the fee directly to the holder of the record.
(i) We do not deny or delay your application if you failed to provide information to verify an eligibility factor in a particular type or form.
(j) Except for eligibility factors listed in WAC 182-503-0505 (3)(c) and (d), we accept alternative forms of verification. If you give us a reasonable explanation that confirms your eligibility, we may not require additional documentation.
(k) Once we verify an eligibility factor that will not change, we may not require additional verification. Examples include:
(i) U.S. citizenship;
(ii) Family relationships by birth;
(iii) Social Security numbers; and
(iv) Dates of birth, death, marriage, dissolution of marriage, or legal separation.
(l) If we cannot verify your immigration status and you are otherwise eligible for Washington apple health, we approve coverage and give additional time as needed to verify your immigration status.
(2) Submission timelines.
(a) We allow at least ten calendar days for you to submit requested information.
(b) If you request more time to provide information, we allow the time requested.
(c) If the tenth day falls on a weekend or a legal holiday as described in RCW 1.16.050, the due date is the next business day.
(d) We do not deny or terminate your eligibility when we give you more time to provide information.
(e) If we do not receive your information by the due date, we make a determination based on all the information available.
(3) Notice requirements.
(a) When we need more information from you to determine your eligibility for ((Washington)) apple health coverage, we send all notices according to the requirements of WAC 182-518-0015.
(b) If we cannot determine you are eligible, we send you a denial or termination notice including information on when we reconsider a denied application under WAC 182-503-0080.
(4) Equal access and limited-English proficiency services. If you are eligible for equal access services under WAC 182-503-0120 or limited-English proficiency services under WAC 182-503-0110, we provide legally sufficient support services.
(5) Eligibility factors for nonmodified adjusted gross income (MAGI)-based programs. If you apply for a non-MAGI program under WAC 182-503-0510(3), we verify the factors in WAC 182-503-0505(3). In addition, we verify:
(a) Household composition, if spousal or dependent deeming under chapter 182-512 WAC or spousal or dependent allowance under chapters 182-513 and 182-515 WAC applies;
(b) Income and income deductions;
(c) Resources, including:
(i) Trusts, annuities, ((and)) life estates, and promissory notes under chapter((s 182-512, 182-513, and)) 182-516 WAC;
(ii) Real property transactions; and
(iii) Financial records, as defined in WAC 182-503-0055, held by financial institutions.
(d) Medical expenses required to meet any spenddown liability under WAC 182-519-0110;
(e) All post-eligibility deductions used to determine cost of care for clients eligible for long-term services and supports under chapters 182-513 and 182-515 WAC;
(f) Transfers of assets under chapter 182-513 WAC and WAC 182-503-0055 when the program is subject to transfer of assets limitations;
(g) Shelter costs for long-term care cases where spousal and dependent allowances apply;
(h) Blindness or disability, if you claim either; and
(i) Social Security number for a community spouse if needed when you apply for long-term care.
(6) Verification for MAGI-based programs.
(a) After we approve your coverage based on your self-attestation, we may conduct a post-eligibility review to verify your self-attested information.
(b) When conducting a post-eligibility review, we attempt to verify eligibility factors using your self-attested information available to us through state, federal, and commercially available data sources, or other third parties, before requiring you to provide information.
(c) You may be required to provide additional information if:
(i) We cannot verify an eligibility factor through other data sources listed in subsection (b) of this section; or
(ii) The information received from the data source is not reasonably compatible with your self-attestation.
(7) Reapplication following post-eligibility review. If your eligibility for MAGI-based ((Washington)) apple health terminates because of a post-eligibility review and you reapply, we may request verification of eligibility factors prior to determining eligibility.
WAC 182-503-0055Asset verification system.
(1) This rule implements the asset verification system (AVS) outlined in section 1940 of the Social Security Act.
(2) This rule applies to the programs described in WAC 182-503-0510 (which includes all applications and renewals for any client and any financially responsible person for such programs), subject to:
(a) The disclosure of resources, as defined in WAC 182-512-0200, to determine eligibility; or
(b) Provisions related to the transfer of assets, as described in WAC 182-513-1363.
(3) For the purposes of this section:
(a) "Financial institution" means the same as defined in section 1101 of the Right to Financial Privacy Act, and may include, but is not limited to:
(i) Banks; or
(ii) Credit unions.
(b) "Financial record" means any record held by a financial institution pertaining to a customer's relationship with the financial institution; and
(c) "Financially responsible person" means a person who is financially responsible as described in WAC 182-506-0015.
(4) You and any other financially responsible people must provide authorization for us to obtain any financial record held by a financial institution.
(5) The authorization, provided under subsection (4) of this section, will remain in effect until one of the following occurs:
(a) Your application for apple health is denied;
(b) Your eligibility for apple health is terminated; or
(c) You revoke your authorization in a written notification to us.
(6) We will:
(a) Use the authorization provided under subsection (4) of this section to electronically verify your financial records and those of any other financially responsible person to determine or renew your eligibility for apple health; or
(b) Inform you in writing at the time of application and renewal that we will obtain and use information available through AVS to determine your eligibility for apple health.
AMENDATORY SECTION(Amending WSR 14-16-052, filed 7/29/14, effective 8/29/14)
WAC 182-503-0080Washington apple healthApplication denials and withdrawals.
(1) We follow the rules about notices and letters in chapter 182-518 WAC. We follow the rules about timelines in WAC 182-503-0060.
(2) We deny your application for ((Washington)) apple health (((WAH))) coverage when:
(a) You tell us either orally or in writing to withdraw your request for coverage; or
(b) Based on all information we have received from you and other sources within the time frames stated in WAC 182-503-0060, including any extra time given at your request or to accommodate a disability or limited-English proficiency:
(i) We are unable to determine that you are eligible; or
(ii) We determine that you are not eligible.
(c) You are subject to asset verification and refuse to provide authorization as described in WAC 182-503-0055.
(3) We send you a written notice explaining why we denied your application (per chapter 182-518 WAC).
(4) We reconsider our decision to deny your ((WAH))apple health coverage without a new application from you when:
(a) We receive the information that we need to decide if you are eligible within thirty days of the date on the denial notice; ((or))
(b) You give us authorization to verify your assets as described in WAC 182-503-0055 within thirty days of the date on the denial notice;
(c) You request a hearing within ninety days of the date on the denial letter and an administrative law judge (ALJ) or HCA review judge decides our denial was wrong (per chapter 182-526 WAC).
(5) If you disagree with our decision, you can ask for a hearing. If we denied your application because we ((don't))do not have enough information, the ALJ will consider the information we already have and ((anymore))any more information you give us. The ALJ does not consider the previous absence of information or failure to respond in determining if you are eligible.